婴儿期条栅视力与3岁神经发育的前瞻性队列研究

Association between infant visual acuity and neurodevelopment at three years of age：a prospective cohort study

摘要

目的：探究婴儿期条栅视力与3岁神经发育的关联。方法：采用前瞻性队列研究设计，纳入2016年8月—2019年6月在江苏出生队列中招募的1 096个家庭的1 122例儿童。在1岁时，使用Teller视力卡Ⅱ测量条栅视力。在3岁时，使用贝利婴幼儿发育量表筛查测试-第3版评估儿童的神经发育情况，包括认知能力、语言理解、语言表达、精细运动和大运动5个维度。运用泊松回归分析两者的关联。结果：在1 122例儿童中，94例（8.4%）出现条栅视力异常。5个维度神经发育欠佳的发生率在3.5%~10.3%。相比条栅视力正常组，婴儿期条栅视力异常组3岁大运动发育欠佳的风险增加96%（RR=1.96，95% CI：1.03~3.70）。排除双胎、早产儿、低出生体重儿及辅助生殖受孕出生的儿童后，该关联仍然显著。结论：婴儿期条栅视力异常与3岁神经发育的大运动维度发育欠佳风险增加相关。

Abstract

Objective：To explore the association between infant visual acuity and neurodevelopment at 3 years of age. Methods：We employed a prospective cohort study design. A total of 1 122 children from 1 096 families enrolled in the Jiangsu Birth Cohort between August 2016 and June 2019 were included. At 1 year of age，visual acuity was measured using the Teller Acuity Card Ⅱ. At 3 years of age，neurodevelopmental status was assessed using the Bayley Scales of Infant and Toddler Development，Version Ⅲ Screening Test，covering five domains：cognition，receptive communication，expressive communication，fine motor，and gross motor. Poisson regression models were used to examine the associations between infant visual acuity and neurodevelopment at 3 years of age. Results：Among the 1 122 children，94（8.4%）showed abnormal visual acuity. The prevalence of noncompetent neurodevelopment across five domains ranged from 3.5% to 10.3%. Compared with the group with normal visual acuity in infancy，the group with abnormal visual acuity had a 96% increased risk of being noncompetent development in gross motor domain at age 3（RR=1.96，95% CI 1.03-3.70）. This association remained stable after excluding twins，preterm infants，low birth weight infants and children conceived via assisted reproductive technology. Conclusion：Abnormal visual acuity in infancy was associated with an increased risk of being noncompetent in gross motor development at 3 years of age.

关键词

条栅视力 / 神经发育 / 认知 / 语言理解 / 语言表达 / 精细运动 / 大运动

Key words

visual acuity / neurodevelopment / cognitive / receptive communication / expressive communication / fine motor / gross motor

参考文献

[1] YANG Y, SHI L, JIN X, et al. Association of perinatal factors with suspected developmental delay in urban children aged 1—36 months—a large—scale cross—sectional study in China[J]. BMC Pediatr, 2023, 23(1):11

[2] STÖRBECK C. Early childhood development is not enough：in defense of children with developmental delays and disabilities and their right to family—centered early childhood intervention(in the global south)[J]. Children(Basel), 2024, 11(5):606

[3] LEE D, BOULTON K A, SUN C, et al. Attention and executive delays in early childhood：a meta—analysis of neurodevelopmental conditions[J]. Mol Psychiatry, 2025, 30(5):1906-1914

[4] KIELY K P, BRAZENDALE K, HILL M, et al. Obesogenic behaviors during structured periods among children and adolescents with intellectual and developmental disabilities：a systematic review and meta—analysis[J]. Int J Behav Nutr Phys Act, 2026, 23(1):21

[5] ÖSTERROOS A, LINDSTRÖM L, WIKMAN P, et al. Maternal body mass index，gestational weight gain，and early childhood growth：a register—based cohort study[J]. Acta Obstet Gynecol Scand, 2024, 103(11):2171-2182

[6] LUBRANO C, PARISI F, CETIN I. Impact of maternal environment and inflammation on fetal neurodevelopment[J]. Antioxidants(Basel), 2024, 13(4):453

[7] LOVE C, SOMINSKY L, O’HELY M, et al. Prenatal environmental risk factors for autism spectrum disorder and their potential mechanisms[J]. BMC Med, 2024, 22(1):393

[8] GARZON—RODRÍGUEZ M C, REYES—FIGUEREDO L S, VELANDIA—RODRÍGUEZ L, et al. Causes of low vision in children：a systematic review[J]. Arch Soc Esp Oftalmol(Engl Ed), 2023, 98(2):83-97

[9] SALOMAO S R, VENTURA D F. Large sample population age norms for visual acuities obtained with vistech—teller acuity cards[J]. Invest Ophthalmol Vis Sci, 1995, 36(3):657-670

[10] THOMPSON R A. Early brain development and public health[J]. Dela J Public Health, 2024, 10(4):6-11

[11] NITZAN I, DERAZNE E, AFEK A, et al. Visual impairment and cognitive performance：a nationwide study of 1.4 million adolescents[J]. Ophthalmic Physiol Opt, 2024, 44(5):819-828

[12] BAKHLA A K, PALLAVI P, KISKU R R, et al. Prevalence of depression in visually impaired children and adolescents：a systematic review and meta—analysis[J]. Indian J Psychiatry, 2023, 65(4):396-403

[13] MAVI S, CHAN V F, VIRGILI G, et al. The impact of hyperopia on academic performance among children：a systematic review[J]. Asia Pac J Ophthalmol(Phila), 2022, 11(1):36-51

[14] FANG C, WU Y, PENG T, et al. Reading speed in school—age children with intermittent exotropia[J]. Sci Rep, 2022, 12(1):9423

[15] NEIJZEN C M, DE WIT F M, HETTINGA Y M, et al. Reference values for the Teller Acuity Cards Ⅱ(TAC Ⅱ)in infants and preverbal children，a meta—analysis[J]. Acta Ophthalmol, 2025, 103(4):479-485

[16] HUA J, LI Y, YE K, et al. The reliability and validity of bayley—Ⅲ cognitive scale in China’s male and female children[J]. Early Hum Dev, 2019, 129:71-78

[17] TAO S, DU J, CHI X, et al. Associations between antenatal corticosteroid exposure and neurodevelopment in infants[J]. Am J Obstet Gynecol, 2022, 227(5):759.e751-759

[18] XIANG Y, LONG E, LIU Z, et al. Study to establish visual acuity norms with Teller Acuity Cards Ⅱ for infants from southern China[J]. Eye(Lond), 2021, 35(10):2787-2792

[19] LAMOUREUX D, YEO S, BHAMBHWANI V. Comparison of binocular reading speed in patients with strabismus without amblyopia versus controls[J]. Can J Ophthalmol, 2025, 60(2):e281-e285

[20] COSTA A, FERRAZ N N, BEREZOVSKY A. Cognitive，motor，and visual development in healthy children in the first 42 months of life[J]. Arq Bras Oftalmol, 2021, 84(5):436-441

[21] SPINELLI M, PUTNICK D L, SHAH P E, et al. Cognitive competences in preterm infants across the first year of life：assessments of continuity，stability，coherence，prediction，and moderation by infant age and country of origin[J]. Int J Behav Dev, 2025, 49(3):299-311

[22] CHORNA O, CORSI G, DEL SECCO S, et al. Correlation between early visual functions and cognitive outcome in infants at risk for cerebral palsy or other neurodevelopmental disorders：a systematic review[J]. Children(Basel), 2024, 11(6):747

[23] MONIR Z M, EL—DIN E M S, KANDEEL W A, et al. Evaluation of apparently healthy Egyptian infants and toddlers on the bayley—Ⅲ scales according to age and sex[J]. Ital J Pediatr, 2024, 50(1):68

[24] KAPLAN P S, DANKO C M, EVERHART K D, et al. Maternal depression and expressive communication in one—year—old infants[J]. Infant Behav Dev, 2014, 37(3):398-405

[25] HENSCH T K. Critical period plasticity in local cortical circuits[J]. Nat Rev Neurosci, 2005, 6(11):877-888

[26] STEFANIA P， MARTINA R， WALTER S， et al. Impact of congenital visual impairment on early—life exploration：behavioral analysis of temporal and motor parameters during a reach—to—grasp playful task[J]. Dev Sci, 2025, 28(5):e70067

[27] ZAREI H, NORASTEH A A, LIEBERMAN L J, et al. The efficiency of sensory systems in postural control of children with and without hearing or visual impairments[J]. PloS one, 2025, 20(5):e0321065

[28] 傅绿函, 施玮, 张胜男, 等. 基于全外显子组测序的1 096例智力障碍或全面性发育迟缓患儿遗传学病因构成分析[J]. 南京医科大学学报（自然科学版）, 2025, 45(6):816-825

[29] FU L H, SHI W, ZHANG S N, et al. Genetic etiology analysis of 1 096 patients with intellectual disability or global developmental delay based on whole exome sequencings[J]. Journal of Nanjing Medical University(Natural Sciences), 2025, 45(6):816-825

基金资助

国家自然科学基金(82473651)

国家自然科学基金(U24A20748)

国家自然科学基金(82574115)